Aggressive behavior can create challenges for healthcare professionals who care for people with Parkinson’s disease. Investigators studying aggressive outbursts toward caregivers were surprised to find that the triggers for these behaviors were not what they anticipated.

The new study, led by the University of Colorado School of Medicine, examined quantitative data from a palliative care clinical trial and qualitative data from interviews with caregivers. Participants shared their experiences, leading to an understanding of the behaviors they experienced and frequent triggers for aggression.

Surprise findings

Reported behaviors ranged from verbal abuse to threats of physical violence. These were typically attributable to difficulties in coping with disease progression, the study’s lead author, Zachary Macchi, MD, reported. Frequent triggers included grief, loss of motor symptoms, confusion, change in functional status and the cognitive fluctuations that characterize Parkinson’s disease.

Macchi and colleagues had expected to find that aggression would also be linked to factors such as having dementia, male sex, being older and having longer disease duration. But those variables were not found to be associated with aggressive behaviors, he said.

Meanwhile, the interviewed caregivers reported that they were unprepared to manage and cope with the behaviors, which they said negatively affected the patient-caregiver relationship. 

Intervention skillsets

The problem of aggression toward caregivers in Parkinson’s disease is underrecognized, Macchi said. He and his colleagues plan to work on interventions, starting with a nationwide survey of neurologists on the current state of aggression management in this disease.

After that, they aim to build “psychoeducation intervention” tools, Macchi said. “We want to give caregivers the tools and skillset to be able to manage [triggers], and to foster an ongoing relationship between the caregiver and the clinician.” 

Full findings were published in the journal Movement Disorders Clinical Practice.

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